As the dust of terrorism is settling down subsequent to the Operation Radd-ul-Fasaad, it is time for our civilian government and us to shed some light on trauma centers and emergency departments of state-run hospitals, which play their role in the fight against terrorism. In circumstances like the recent terrorist attacks in Lahore and Shrine of Lal Shahbaz Qalandar, these emergency departments, in secondary and tertiary care hospitals, had a vital impact on the number casualties after each heartbreaking event.
Pakistan is a country plagued by natural disasters as well as man-made disasters. This challenge is like any other faced by a developing country in the world. Emergency care in Pakistan is of the utmost significance, as it’s the first line of defense against terrorism, on the medical front. But in its chain of saviors one link is missing: the pharmacist. There is an immediate need of the pharmacist in emergency management teams in Pakistan, whether it is the emergency department of a government or private hospital, or first responders like Rescue 1122 – the pharmacist is missing.
This is an immediate step to be taken in emergency, for safety of the patient. Even though we are way behind in the budget allocation for the emergency services in comparison to the developed world, this is a part where effort can be made to get closer to the target with just adding a link to the chain and piece to the puzzle, as we have the talent pool to pick from. Pharmacists have a huge role in health care system regarding the safety and efficacy of the medicine and patient care. Much of what I have to say is more like an ode from a registered pharmacist, for the sake of saving lives.
Emergency preparedness is a public health tool which can be used to reduce the high numbers of casualties in trauma incidents related to natural hazards and terrorism. We have a multi-tiered response in Pakistan. From National Disaster Management Authority to Rescue 1122, we have all dealt with one of the ‘response forces’ on our roads, in cities, in any given province. These have cradled from the brain child of conscious efforts to utilize state resources in the best possible way for public service in hours of great need. Equally, these initiatives have also cashed the highest praise from the masses, for any government that starts or further develops them.
Now you may know who a pharmacist is: someone who dispenses your medicines off the counter upon your doctor’s prescription – conversely, it’s just the tip of the iceberg that you have witnessed. The pharmacist is involved in usual chores of a pharmacy, where he/she maintains, mobilizes, distributes and receives a stockpile of medicines and ensures the safety and efficacy of drugs. Not to mention the pharmacist safeguards the reserves of antidotes and vaccines, making sure of their availability from potassium iodide tablets to polio vaccines. Equipped with knowledge of drugs, the pharmacist is an integral part for pharmaceutical care in a medical team. Those who have been to private hospitals like Agha Khan Hospital or Shaukat Khanum Memorial Cancer Hospital, must have seen their role and the difference made by the presence of a pharmacist, in full force where they are found vehemently educating patients and helping in rational utilization healthcare expenditure.
Since the terror attacks of 9/11, America has developed a pragmatic pharmacy emergency response team (PERT) that is integrated in its disaster management teams, where pharmacists are dealing with, administrative, drug information, critical care, infectious diseases, management information, hazardous material, and auxiliary-site roles to deal with challenges ranging from chemical to biological acts of terrorism and bioterrorism. Their on-spot presence helps detect, mitigate, treat and prevent any possible casualties resulting from such tragic events.
An instance on our end, in a day's routine work of a pharmacist dealing with emergency department, can be derived from the close-to-ideal conditions. In the presence of a computerized prescriber order entry (CPOE) system, the order of prescription comes on ambulatory pharmacy desk and dispensed correctly, immediately or within 10-15 minutes. Now, if a patient is admitted with a wound injury and is prescribed an antibiotic by a doctor who is overburdened with numerous other patients as result of a terrorist attack and orders a 100 mg in hast while the correct dose is 1000 mg, an under dose harmless for a drug that’s administered once in a day, can aggravate the patient’s condition due to infection. The pharmacist intervenes, communicates with the prescriber and dispenses the right dose. A step is taken to save a life. Here, I want to accentuate that none of this is to undermine the work of doctors and nurses but to rather take the burden, rightfully, off their shoulders.
The current state is quite grim. In case of any trauma accident or event of terrorism, the patients with severe injury, rich or poor, are not sent to a private hospital due to proceedings of police cases. Thus, they are taken to public healthcare hospitals, district headquarter hospital or tertiary care hospitals. Either the hospital does not have a pharmacy for ambulatory care, or not even a pharmacy linked to the emergency department in the first place. The worse angle is that they do not even have a pharmacist on the emergency department, nay I say, a specialized clinical pharmacist. Moreover Rescue 1122 that is the emergency first responder, has paramedics and doctors on their teams, but not a single pharmacist. Much of the medicine is procured from pharmacies adjacent to the hospitals and prescriptions are dispensed without any interventions, leading to patients’ fear of being prone to medical errors. In such a case, a pharmacist can help in managing medication errors in ambulatory care that doing so, on the frontline in an emergency department. Yet, in Pakistan, we don’t have any specialized pharmacist in ambulatory care, and no one noticed.
Currently, we do have American Board Certified Pharmacist in a very small number of leading private hospitals, playing their part in saving lives; nonetheless, their number is very minuscule. Thus far, they need to be given incentives to revere them and promote more pharmacists to reach this level. Their work in healthcare team is shown by contribution to educating healthcare professionals as well as patients, and most of all saving money and medicine, in their respective hospitals. Personnel like these are a key to generating a specialized work force for future through initiatives of specialized yearly training programs. The government can take on the task to instate such pharmacists or those trained by them, on emergency basis in its hospitals’ emergency department, to help curb deaths from terrorism, if ever needed as a result of an unfortunate event.